Nightsong
Senior Member (Voting Rights)
Amongst the poster presentations from the Canadian Pain Society's 2026 conference were two from the McMaster group. Apparently a guideline endorsing GET is in the works.
95 | Physical activity for myalgic encephalomyelitis/chronic fatigue syndrome: A clinical practice guideline
118 | The benefits and harms of physical activity for patients with myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review and meta-analysis of randomized trial
Canadian Pain Society - Book of Poster Presentations (p78 and p102 of the PDF)
95 | Physical activity for myalgic encephalomyelitis/chronic fatigue syndrome: A clinical practice guideline
Introduction: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterized by persistent fatigue, post-exertional malaise (PEM) and cognitive dysfunction. The role of exercise remains contentious, and the 2021 NICE Guideline made a strong recommendation against graded exercise therapy for ME/CFS. We present a clinical practice guideline for physical activity in adults with ME/CFS.
Objective: To develop recommendations on physical activity for adults with ME/CFS.
Methods: A multidisciplinary guideline panel, including 3 patient partners, 9 clinical experts, and 6 methodologists, reviewed evidence from a systematic review of randomized trials evaluating the effectiveness of any form of exercise for ME/CFS. Certainty of evidence was assessed using the GRADE approach, and judgments considered the balance of benefits, harms, and patient values and preferences.
Results: Our systematic review found moderate certainty evidence that, compared to pacing or usual care, graded physical activity likely decreases fatigue, reduces the risk of PEM, and increases the likelihood of patient-reported recovery, with little to no difference in adverse events. Results were similar for traditional Eastern movement therapy, but the certainty of evidence was very low for PEM and recovery. The panel made a strong recommendation to offer a trial of graded physical activity to adults with ME/CFS. The panel made a conditional recommendation to offer people living with ME/CFS who decline a trial of graded physical activity, or who experience problematic symptoms despite a trial of graded physical activity, a trial of traditional Eastern movement therapy.
Discussion/Conclusions: Our recommendations will promote evidence-based use of exercise therapy for ME/CFS.
Objective: To develop recommendations on physical activity for adults with ME/CFS.
Methods: A multidisciplinary guideline panel, including 3 patient partners, 9 clinical experts, and 6 methodologists, reviewed evidence from a systematic review of randomized trials evaluating the effectiveness of any form of exercise for ME/CFS. Certainty of evidence was assessed using the GRADE approach, and judgments considered the balance of benefits, harms, and patient values and preferences.
Results: Our systematic review found moderate certainty evidence that, compared to pacing or usual care, graded physical activity likely decreases fatigue, reduces the risk of PEM, and increases the likelihood of patient-reported recovery, with little to no difference in adverse events. Results were similar for traditional Eastern movement therapy, but the certainty of evidence was very low for PEM and recovery. The panel made a strong recommendation to offer a trial of graded physical activity to adults with ME/CFS. The panel made a conditional recommendation to offer people living with ME/CFS who decline a trial of graded physical activity, or who experience problematic symptoms despite a trial of graded physical activity, a trial of traditional Eastern movement therapy.
Discussion/Conclusions: Our recommendations will promote evidence-based use of exercise therapy for ME/CFS.
118 | The benefits and harms of physical activity for patients with myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review and meta-analysis of randomized trial
Introduction: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a condition characterized by persistent fatigue, post-exertional malaise, cognitive dysfunction, and unrestful sleep. For decades, guidelines recommended graded physical activity (GPA) to improve patients’ physical capacity, though concerns about post-exertional malaise, a defining characteristic of ME/CFS, have led many to question its safety and effectiveness.
Objective: To systematically review and summarize evidence from randomized trials on the benefits and harms of physical activity for adults with ME/CFS.
Methods: We searched MEDLINE, EMBASE, PsycInfo, and CENTRAL from inception to July 2024 for randomized controlled trials comparing physical activity with usual care, pacing, or cognitive and behavioral interventions in adults diagnosed with ME/CFS. Reviewers worked independently and in duplicate to screen records, extract data, and assess risk of bias. We performed random-effects meta-analyses and rated the certainty of evidence using the GRADE approach.
Results: Twenty trials (38 records; n=2,798) proved eligible. Moderate certainty evidence suggests that GPA probably reduces fatigue compared with control (mean difference [MD] - 6.14, 95% CI -9.95 to -2.33) and probably decreases post-exertional malaise (risk difference [RD] -17.2%, 95% CI -25.8% to -7.9%). The addition of cognitive behavioral therapy to GPA provided little or no additional benefit for fatigue (MD -0.60, 95% CI -2.21 to 1.01). Moderate certainty evidence suggests that traditional Eastern movement therapies probably reduce fatigue (MD -2.85; 95% CI -4.07 to -1.64).
Discussion/Conclusions: Graded exercise and Eastern movement therapies likely improve fatigue in adults with ME/CFS. These findings will inform forthcoming guideline recommendations on the management of ME/CFS.
Objective: To systematically review and summarize evidence from randomized trials on the benefits and harms of physical activity for adults with ME/CFS.
Methods: We searched MEDLINE, EMBASE, PsycInfo, and CENTRAL from inception to July 2024 for randomized controlled trials comparing physical activity with usual care, pacing, or cognitive and behavioral interventions in adults diagnosed with ME/CFS. Reviewers worked independently and in duplicate to screen records, extract data, and assess risk of bias. We performed random-effects meta-analyses and rated the certainty of evidence using the GRADE approach.
Results: Twenty trials (38 records; n=2,798) proved eligible. Moderate certainty evidence suggests that GPA probably reduces fatigue compared with control (mean difference [MD] - 6.14, 95% CI -9.95 to -2.33) and probably decreases post-exertional malaise (risk difference [RD] -17.2%, 95% CI -25.8% to -7.9%). The addition of cognitive behavioral therapy to GPA provided little or no additional benefit for fatigue (MD -0.60, 95% CI -2.21 to 1.01). Moderate certainty evidence suggests that traditional Eastern movement therapies probably reduce fatigue (MD -2.85; 95% CI -4.07 to -1.64).
Discussion/Conclusions: Graded exercise and Eastern movement therapies likely improve fatigue in adults with ME/CFS. These findings will inform forthcoming guideline recommendations on the management of ME/CFS.
Canadian Pain Society - Book of Poster Presentations (p78 and p102 of the PDF)
